Substance use and associated emotional and behavioral problems in Nepalese adolescents

Background: Research has demonstrated that problem behavior has been associated with substance use, but knowledge is lacking on such associations in a low-income country like Nepal. Aims: This study aimed to find associations between emotional and behavioral problems and substance use among Nepalese adolescents. Method: A cross-sectional study was conducted at the end of 2011, with participants from three schools in the Province 4 of Nepal. We selected 408 adolescents aged 12 to 18 (mean 15.2 years, 54% boys) at one urban and two rural schools. The data were collected using the Youth Self-Report and Adolescents’ Substance Use Measurement. Results: Higher scores on withdrawn/depressed symptoms, thought problems, attention problems, delinquent or aggressive behavior or internalizing or externalizing problems were associated with the use of tobacco, alcohol or other substances. In the broadband scales, only internalizing problems predicted the use of intoxicants. Higher scores for attention problems predicted the use of tobacco, any intoxicants, and high-risk user. Conclusion: Our findings indicated that problem behavior among Nepalese adolescents was associated with substance use. Future studies should explore the association between problem behavior and substance use, including causal factors, so that risky behavior among Nepalese adolescents can be prevented.     

Intravenous drug dependence in adolescence

Purpose To explore psychosocial background and preceding substance use related to intravenous drug dependence (IDD) among adolescents.

Methods A clinical sample of 278 adolescents (age 12–17) admitted to psychiatric inpatient hospitalization between April 2001 and January 2004 was studied. Data concerning psychosocial variables and substance use were gathered from the Schedule for Affective Disorder and Schizophrenia for School‐Age Children Present and Lifetime (K‐SADS‐PL), the European Addiction Severity Index (EuropASI) and the interview schedule of the First Treatment Demand protocol of the Pompidou Group of the Council of Europe.

Results The prevalence of IDD was increased if the adolescent was living without biological father or mother, had history of truancy or had been transferred to special class. Initiation age of IDD was significantly lower if the adolescent was living without biological father or mother, the mother of the adolescent was employed full‐time or if the adolescent had been transferred to special class. Early substance experiment was associated with IDD and with earlier initiation of intravenous use. The progression from regular tobacco use to IDD was faster among girls compared to boys.

Implications Common milestones in the progression of IDD are school problems, disturbed relations to parents and previous substance experiments at young age.     

The Association of Family and Peer Factors with Tobacco, Alcohol, and Marijuana Use Among Chilean adolescents in Neighborhood Context

Research on adolescent use of substances has long sought to understand the family factors that may be associated with use of different substances such as alcohol, tobacco and marijuana. However, scant attention has been focused on these questions in Latin American contexts, despite growing concerns about substance use among Latin American youth. Using data from a sample of 866 Chilean youth, we examined the relationship of family and neighborhood factors with youth substance abuse. We found that in a Latin American context access to substances is an important predictor of use, but that neighborhood effects differ for marijuana use as opposed to cigarettes or alcohol. Age of youth, family and peer relationships, and gender all play significant roles of substance use.The study findings provide additional evidence that the use of substances is complex whereby individual, family, and community influences must be considered jointly to prevent or reduce substance use among adolescents.     

School health nurses and substance use among adolescents - towards individual identification and early intervention

Adolescents' health is today threatened by the use of alcohol and other psychoactive substances. It is therefore important to develop interventions related to substance use in school health care. The aim of this study was to examine the empowering or risk background factors related to substance use among adolescents, and the ability of school nurses (PHN) to identify these factors and to provide needed individual early intervention. The data were collected by semistructured questionnaires completed by 14- to 18-year-old adolescents (n = 326, response rate 79) and PHNs (n = 10) in 2004. The adolescent questionnaire consisted of items related to the respondents' background and Adolescents' Substance Use Measurement (ADSUME). Following individual consent, adolescents' ADSUME responses were sent to the PHNs for intervention. The PHNs assessed the adolescents' empowering background factors and intervention using the questionnaire, and 70% (n = 228) of their answers matched the adolescents' answers. The data were analysed with the SPSS software using the chi-squared test, Fisher's exact test, kappa coefficient and agreement percentages. Substance use among adolescents was associated with parental support, mother's education and smoking, the adolescents' knowledge about substances, peer support and hobbies. The PHNs' assessments regarding supportive background were not in agreement with the assessments of adolescents who were using hazardous substances. One-fifth of the adolescents received the brief intervention, although many of them might have needed extra support and follow-up on the basis of their ADSUME results. The research findings can be generalized only for alcohol use, because only 3% of the study informants used substances other than alcohol. Further research is warranted concerning PHNs' ability to identify hazardous substance use and to ensure preventive early intervention and requisite support among substance-using adolescents in order to improve evidence-based health promotion.     

Family influences on the use of e-cigarettes

E-cigarette use among adolescents continues to rise. However, little research has examined factors that influence adolescent e-cigarette use. The goal of the current study was to better understand family influences (i.e., perceptions of parental attitudes and sibling use) of e-cigarette use and determine how these influences on e-cigarette use compared to their influence on other substances (i.e., alcohol, traditional tobacco, and marijuana). A sample of 279 9^th to 12^th graders completed surveys, and results indicated that adolescents perceive that their parents feel that e-cigarettes are less wrong than traditional tobacco use and similarly wrong to marijuana use. Siblings used traditional tobacco at a higher rate than e-cigarettes and marijuana, which siblings have used at similar rates. Alcohol was perceived to be the substance that parents felt was least wrong to use and the most used substance by siblings. Perceptions of parental attitudes toward substances were related to adolescent use of all substances. Sibling use was positively associated with traditional tobacco, e-cigarette, and marijuana use, but not alcohol use. Thus, it appears that adolescent e-cigarette use is influenced by both parental attitudes and sibling use.     

The influence of parents and friends on adolescent substance use: a multidimensional approach

Objective: The current study examined longitudinal associations between friend's substance use, friendship quality, parent-adolescent relationship quality, and subsequent substance use among an adult population. Design: Participants were 166 adolescents, their parents, and their close same-sex friends recruited from both urban and suburban high schools surrounding a large metropolitan area. Measures of relationship characteristics in the10th grade were used to predict concurrent substance use and changes in substance use over a 1-year period. Results: The most consistent predictor of the use of different substances and changes in substance use over time was the friend's substance-using behavior. Negative interpersonal interactions with a friend were related only to tobacco use, and friendship support neither contributed to nor protected against substance use. Mother-adolescent relationship support was associated with lower levels of concurrent substance use, as well as lower levels of hard drug use over time. Conclusions: Findings highlight the need to examine parents and peers simultaneously and the importance of parental relationships and peer behavior on adolescent substance use. Limitations and future directions are discussed.     

Alcohol and other drug use among adolescent detainees

This paper seeks to describe alcohol and other drug use among a sample of 2280 male and female adolescent detainees at two state juvenile justice facilities. Substance use was explored by age of initiation, race/ethnicity, gender, delinquent behaviours, and recidivism. Results indicated that alcohol and marijuana were the substances of choice, followed by powder cocaine and ecstasy and other designer drugs. Alcohol use also preceded marijuana use for both males and females. Males engaged in more alcohol and other drug use than females, and they engaged in marijuana use at a younger age. White adolescents reported more alcohol use than adolescents in all other racial/ethnic categories, while there were no differences in marijuana use. White adolescents, however, were younger when they began using marijuana. Finally, adolescents who engaged in alcohol and other drug use reported more delinquent activities and were more likely to have been detained previously. The results of this study are discussed in the context of other studies examining substance use in the general adolescent population and in at‐risk and detained adolescents.     

Gender differences in psychoactive substance use among undergraduates in a developing country

ABSTRACT

Background: The use of psychoactive substances constitutes one of the leading social problems confronting students. Some gender differences have been reported in the use of substances.

Aim and objectives: To identify the gender differences in substance use among students in Nigeria.

Methods: This was a cross-sectional study conducted among 763 students of Imo State University Owerri. A self-administered structured questionnaire was used to obtain the socio-demographic data and information on the reasons, and consequences of substance use.

Results: A total of 763 students were studied. More males used substances compared to females (χ2 = 10.6, p?0.01). More females used psychoactive substances out of curiosity (51.9%), and because a family member used psychoactive substance (55.7%). More males used psychoactive substances to be accepted by friends (χ2 = 7.33, p?0.01), to make life more enjoyable (χ2 = 18.6, p? 0.01), to appear bold and strong (χ2 = 21.7, p < .01), and to cope with the stress (χ2 = 6.52, p?0.01). Skipping classes regularly (χ2 = 6.98, p?0.01) and being charged for sexual molestation (χ2 = 5.64, p?0.02) were more among those who abused substances.

Conclusion: There are differences in the rate and reasons for the use of psychoactive substances between the genders. In the design of preventive approaches in students, these should be borne in mind.     

Aspects of control and substance use among middle‐aged and older adults with bipolar disorder

High prevalence rates of alcohol and substance use disorders have been reported among persons with bipolar disorder (BD). In the present study, we explored the daily experiences of middle‐aged and older adults living with BD who reported regular substance use and the ways in which participants expressed ‘control’ in relation to their use of alcohol and other substances. Semistructured, in‐depth interviews were conducted with 12 participants (nine women and three men), aged 36–57 years of age (mean = 49 years). Thematic analyses identified emergent themes and patterns in participants’ life histories. The theme of ‘control’ emerged as central to participants’ reports, and was organized into four categories: (i) substance use to control BD symptoms; (ii) substance use provides a sense of being in control; (iii) methods of controlled substance use; and (iv) not having control: overreliance on substances. Implications of the present study include the need for nurses to openly discuss the use of alcohol and other drugs with persons with BD, provide health information and screening, and determine whether persons with BD feel they have control over their substance use. Several lines of research with persons who have BD and use substances are suggested.     

How Illegal Drug Use,Alcohol Use,Tobacco Use,and Depressive Symptoms Affect Adolescent Suicidal Ideation: A Secondary Analysis of the 2011 Youth Risk Behavior Survey

The purpose of this study was to identify the major risk factors among adolescents who have either contemplated or attempted suicide. Along with successful suicides, suicide attempts and contemplation are coexisting factors that are prominent in the adolescent population and therefore warrant major concern. A secondary data analysis of the Youth Risk Behavior Survey (YRBS) was completed to explore the factors that may influence adolescents’ thoughts or actions about suicidal behavior. The YRBS represents high-school students throughout 50 states. Nine questions from the YRBS were used to elicit information about the relationships among the risk factors: (1) Suicidal thoughts and attempts; (2) illegal drug use; (3) alcohol use; (4) tobacco use; and (5) depressive symptoms. Statistically significant relationships among the risk factors were found for adolescents. Adolescents considered suicide (15.8%); attempted suicide at least once (7.8%); were injured while attempting suicide (n = 2.7%). Our findings support the idea that illegal substance use can lead to suicidal thoughts and actions. Depression had a positive relationship with suicidal ideations, supporting similar studies suggesting that depression leads to suicidal action.     

The relationship between adolescent depressive symptomology and substance abuse

The research aimed to investigate the phenomena of adolescent depressive symptomology, substance abuse and the relationship between the two phenomena in a South African context. The influence of moderator variables was also examined. Another objective was to determine risk factors for the before mentioned. This was done by using a questionnaire with a sample of 1298 conveniently selected adolescents in a South African high school. It was determined that adolescents become progressively unhappier from 13 to 17 years of age. Girls are more depressed than boys. This research also revealed that adolescent depressive symptomology is significantly and positively correlated with earlier age of onset of substance abuse as well as frequency of usage. There appear to be no gender differences in substance abuse but teenagers from different ethnic and language groups differ in their use of substances. Risk factors for depression and substance abuse included a conflict relationship with parents, the experience of major stressful events, dissatisfaction with school grades and friends' use of substances.     

Addressing Substance Use in Adolescents: Screening,Brief Intervention,and Referral to Treatment

Adolescent substance use is a national public health crisis. The most commonly used substances among adolescents are nicotine, alcohol, and marijuana. Use of these substances during adolescence has serious adverse effects on brain development, with impairments that can endure into adulthood. Advanced practice nurses in primary care can address substance use in the adolescent population with the use of evidence-based interventions, such as Screening, Brief Intervention, and Referral to Treatment (SBIRT). This article describes trends in adolescent substance use and use of the SBIRT intervention for low, medium, and high-risk use in this population.     

Identification of novel psychoactive drug use in Sweden based on laboratory analysis – initial experiences from the STRIDA project

Abstract

Aim. The study aimed to collect information concerning the increasing use of new psychoactive substances, commonly sold through online shops as ‘Internet drugs’ or ‘legal highs’, or in terms of masked products such as ‘bath salts’ and ‘plant food’. Methods. The Karolinska Institutet and Karolinska University Laboratory and the Swedish Poisons Information Centre have initiated a project called ‘STRIDA’ aiming to monitor the occurrence and trends of new psychoactive substances in Sweden, and collect information about their clinical symptoms, toxicity and associated health risks. A liquid chromatographic-tandem mass spectrometric (LC-MS/MS) multi-component method has been developed, currently allowing for the determination of > 80 novel psychoactive compounds or metabolites thereof. This study focused mainly on the particular drug substances identified and the population demographics of the initial STRIDA cases. Results. In urine and/or blood samples obtained from 103 consecutive cases of admitted or suspected recreational drug intoxications in mostly young subjects (78% were ≤ 25 years, and 81% were males) presenting at emergency departments all over the country, psychoactive substances were detected in 82%. The substances comprised synthetic cannabinoids (‘Spice’; JWH analogues), substituted cathinones (‘bath salts’; e.g. butylone, MDPV and methylone) and tryptamines (4-HO-MET), plant-based substances (mitragynine and psilocin), as well as conventional drugs-of-abuse. In 44% of the cases, more than one new psychoactive substance, or a mixture of new and/or conventional drugs were detected. Conclusion. The initial results of the STRIDA project have documented use of a broad variety of new psychoactive substances among mainly young people all over Sweden.     

Impact of pregnancy on psychoactive substance use among women with substance use disorders recruited in addiction specialized care centers in France

Pregnancy can be a motivation for decrease in drug abusing but may also represent a period of high vulnerability for relapse. We aimed to assess psychoactive substance use among women with substance use disorders followed in addiction care centers in France. We analyzed data from women aged 15–44 years included in the ‘Observation of illegal drugs and misuse of psychotropic medication (OPPIDUM) survey’, an annual cross‐sectional survey collecting details on psychoactive substances used. Characteristics of women included in 2005–2012 yearly surveys were compared depending on their pregnant or not pregnant status. Factors, including pregnancy, associated with illicit substance use and medication misuse were investigated through logistic regression. The study included 518 pregnant and 6345 nonpregnant women; 85.3% pregnant women were on opioid maintenance therapy (OMT) (vs. 77.1% of nonpregnant). Pregnancy was associated with lower illicit substance use (adjusted OR 0.71 [0.58–0.88]) and with lower medication misuse (0.66 [0.49–0.89]), whereas financial insecurity and living as a couple were associated with increased risk. Raising children was significantly associated with less risk of substance use. Each substance taken separately, the part of women using illicit substance or misusing medication did not differ depending on whether they were pregnant or not, except for heroin (24.5% in pregnant vs. 17.9% nonpregnant; <0.001). This nationwide study provides new insights into psychoactive substance use in a large mixed population of women with drug use disorders. Results outline the challenge of preventing drug use and initiating care strategies with a specific approach on socio‐economic environment.     

Gearing up for the millennium

Abstract

Objective: The objective of this study was to estimate the prevalence of current alcohol use and its association with cigarette and drug use among 13–15-year-olds in Africa and the Americas.

Method: Cross-sectional data of the WHO Global School-based Student Health Survey from nine countries in the WHO African Region and seven countries/territories in the WHO Region of the Americas were analysed. Single and joint prevalence rates, and prevalence odds ratios were computed.

Results: In the majority of countries, alcohol was the most often consumed psychoactive substance, with the prevalence of current alcohol use outweighing the prevalence of current cigarette and lifetime drug use. Gender differences for alcohol were not marked. The use of alcohol was strongly associated with cigarette or drug use, indicating clustering.

Conclusions: For the bulk of countries in the Americas and for single countries in Africa, current alcohol use is as high as prevalence rates occurring in other parts of the world. It is imperative to monitor psychoactive substance use among adolescents in these countries to be able to prevent future health and social harm with the information gained.     

Volatile substance misuse

The UK Government's policy statement, Tackling Drugs Together (1995), focuses on illegal drugs, while recognizing that legal substances may also be targeted in local strategies. Government guidance for drug prevention in schools specifically includes advice on dealing with tobacco, alcohol and volatile substances. This is appropriate, because these substances are more likely to be misused than illegal drugs by school-age children. Focusing on these readily available substances highlights the difficulty of controlling the supply of intoxicants. This is particularly true of volatile substances, which are ubiquitous. The difficulty of controlling supply was one of the issues tackled by a UK government committee which examined the problem of volatile substance misuse. The report made suggestions about product labelling, product modification, product replacement and retail staff training, but recognized that supply-side measures were, by themselves, not sufficient. They therefore stressed the importance of public awareness and they endorsed drug education in schools as a means of developing decision-making skills. Attempting to tackle volatile substance misuse alerts us to the difficulties of relying solely on supply controls and, in a world where drugs are a part of people's lives, highlights the need for multiple strategies in dealing with them.     

Prevalence of psychoactive substance use among male adolescents in Southwest Nigeria

Introduction: Substance use in the adolescent period is recognized as a growing problem in Nigeria. The problem is even more significant among male adolescents in southwest Nigeria with consequent legal and academic problems.

Objectives: The study aimed to describe the pattern of substance use among male secondary-school adolescents and identify sociodemographic correlates of substance use.

Methods:. A total sampling of male students in senior classes of secondary schools selected randomly from urban and semi-urban areas of Ibadan a city in Nigeria were approached for the study.

Results: The mean age of the respondents was 16.49 years (SD ±1.31). Lifetime use of any psychoactive substance was 54%. The most common substance ever used by respondents were non-amphetamine stimulants (39%) followed by alcohol (31%) while hallucinogens (1.0%) and cocaine (1.0%) were the least ever used. None of the respondents had never used an amphetamine-type stimulant. Seven of the respondents (2.9%) reported ever using a psychoactive substance though injection in the last 3 months.

Conclusion: This study reports a high prevalence of psychoactive substance use among male secondary-school adolescents in Ibadan southwest Nigeria. It showed that being in a higher class and engaging in paid work after school were factors significantly associated with substance use. The findings of this study have implications for adolescent mental health intervention in the field of addiction.     

A Research Agenda for Gender and Substance Use Disorders in the Emergency Department

For many years, gender differences have been recognized as important factors in the etiology, pathophysiology, comorbidities, and treatment needs and outcomes associated with the use of alcohol, drugs, and tobacco. However, little is known about how these gender‐specific differences affect ED utilization; responses to ED‐based interventions; needs for substance use treatment and barriers to accessing care among patients in the ED; or outcomes after an alcohol‐, drug‐, or tobacco‐related visit. As part of the 2014 Academic Emergency Medicine consensus conference on “Gender‐Specific Research in Emergency Care: Investigate, Understand and Translate How Gender Affects Patient Outcomes,” a breakout group convened to generate a research agenda on priority questions related to substance use disorders.